Teen boys who view themselves as too skinny despite being a healthy weight are more likely to be depressed, according to two new studies published in Psychology of Men & Masculinity.
Such depression can persist into adulthood for some and is more common in those who think they are too thin than those who perceive themselves as overweight, the researchers found.
A second study, published in the same journal, found that those who feel they are underweight and are the victims of bullying are more likely to resort to steroid use than their peers.
"These studies highlight the often underreported issue of distorted body image among adolescent boys," said Aaron Blashill, staff psychologist at Massachusetts General Hospital and faculty member at Harvard Medical School. Blashill led both studies.
"Teenage girls tend to internalize and strive for a thin appearance, whereas teenage boys tend to emphasize a more muscular body type," he said. "We found that some of these boys who feel they are unable to achieve that often unattainable image are suffering and may be taking drastic measures."
The study was based on two nationally representative groups of teenage boys, the first of which included more than 2,000 boys. The participants were about 16 years old in 1996 and were followed for the next 13 years through a number of surveys. Questions included how the participants ranked their current weight, which was then compared to his body mass index.
Those who saw themselves as underweight despite being average weight or higher reported the highest rate of depressive symptoms - findings that remained the same throughout the study.
The other study used data from a 2009 nationally representative survey of more than 8,000 high school-aged boys. Four percent of the participants in this study reported steroid use and 3 percent viewed themselves as underweight. According to the researchers, those who saw themselves as underweight were more likely to be bullied and report depressive symptoms, which led to steroid use.
Based on this, the study's authors suggest that clinicians working with depressed teenage boys should be sensitive to possible steroid use, in particular if the patient thinks he is underweight or reports being bullied based on his appearance.
"Unfortunately, there is little evidence-based research on effective therapies for steroid use among adolescent boys," Blashill said. "However, cognitive-behavioral therapy has proven to be effective for body image concerns and could be helpful for boys considering using or already using steroids."
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